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Last reviewed: 14 Mar 2025
Last updated: 01 Nov 2024

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • enlarged lymph node
  • pleuritic chest pain
  • skeletal pain
  • urinary symptoms
  • abdominal swelling
  • abdominal pain
  • headache

Other diagnostic factors

  • cough
  • altered mental status
  • neurological symptoms
  • hepatomegaly
  • abnormal chest examination
  • fever
  • weight loss of more than 10% body weight
  • anorexia
  • malaise
  • night sweats
  • dyspnoea
  • asymptomatic
  • erythema nodosum and erythema induratum

Risk factors

  • exposure to TB
  • born in Asia, Latin America, or Africa
  • HIV infection
  • immunosuppressive medicines
  • haematological or head/neck malignancy
  • end stage renal disease
  • apical fibrosis
  • intravenous drug use
  • female sex
  • Asian, black, and Native American ethnicity
  • malnutrition
  • alcoholism
  • diabetes
  • cirrhosis
  • high-risk congregate settings
  • low socioeconomic status
  • very young age

Diagnostic investigations

1st investigations to order

  • chest x-ray
  • sputum smear
  • sputum culture
  • FBC (full blood count)
  • lymph node fine-needle aspiration
  • pleural fluid analysis
  • ascitic fluid analysis
  • bone films
  • cerebrospinal fluid analysis
  • urinalysis
  • nucleic acid amplification test (NAAT)

Investigations to consider

  • lymph node biopsy
  • pleural biopsy
  • synovial biopsy
  • liver biopsy
  • bone marrow biopsy
  • blood culture
  • peritoneal biopsy
  • gastric aspirate
  • bronchoscopy
  • thoracoscopy
  • drug susceptibility testing
  • genotyping
  • HIV test
  • lateral flow urine lipoarabinomannan (LF-LAM) assay
  • empiric treatment
  • CT scan chest or abdomen
  • abdominal ultrasound
  • colonoscopy
  • pericardial fluid analysis
  • pericardial biopsy
  • tuberculin skin testing
  • interferon-gamma release assays
  • TB antigen-based skin tests (TBST)

Treatment algorithm

Contributors

Authors

David J. Horne, MD, MPH
David J. Horne

Associate Professor

Division of Pulmonary, Critical Care, and Sleep Medicine

University of Washington

Seattle

WA

Disclosures

DJH declares that he has no competing interests.

Masahiro Narita, MD
Masahiro Narita

Professor of Medicine

Division of Pulmonary, Critical Care, and Sleep Medicine

University of Washington

Co-Founder

Firland Northwest TB Center

Seattle

WA

Disclosures

MN declares that he has no competing interests.

Peer reviewers

Carlos Acuña-Villaorduña, MD

Infectious Diseases Physician

Boston University Medical Center

Boston

MA

Disclosures

CA-V declares that he has no competing interests.

James Shepherd, V

Infectious Disease Consultant

Yale University School of Medicine

New Haven

CT

Disclosures

JS declares that he has no competing interests.

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